Hyperphosphatemia in end-stage renal disease (ESRD) patients is a non-traditional risk factor for all-cause and cardiovascular mortality. Non-adherence to phosphate binders is as high as 74% in ESRD patients and has been shown to be most related to psychosocial factors including attitudes. There is limited data on the influence of attitudes and perceived autonomy support on phosphate binder adherence and these two psychosocial constructs can be positively influenced through the use of motivational interviewing skills to increase autonomous motivation. Furthermore, racial disparities are known to exist in ESRD however and there are still gaps, which exist in understanding the determinants of disparities in adherence in vulnerable patients with ESRD. The PI conducted a pilot study in100 prevalent dialysis patients, which revealed that positive attitudes correlated with higher binder medication adherence (p=0.04) and medication adherence correlated with serum phosphorus levels (p<0.001). Greater perceived autonomy support was associated with both better medication adherence (p=0.017) and better phosphorus control and subtle underlying differences by race were noted. The overarching objective of this proposal is for the PI to gain critical research experience and skills by determining the impact of motivational interviewing on phosphate binder adherence in diverse ESRD patients. Through this project, the PI will gain valuable research experience in study design, implementation, analysis and dissemination of research findings, and these will effectively set the foundation for a successful career as a patient-oriented clinical investigator. The PI has outlined a training plan that integrates structured research training through the MPH Program; a mentored research experience; participation in local and national research meetings / conferences and active involvement in an innovative and extremely supportive research environment. This proposed award will facilitate the PI to gain experience and comprehensive training in patient-oriented clinical research to (a) successfully obtain a career development research award to address disparities in kidney disease and ultimately to (b) set the stage for an independently funded research career identifying and overcoming gaps in care by leading behavioral clinical trials testing novel multi-level strategies and translating them to clinical care.